Provider Demographics
NPI:1386481638
Name:CAMPBELL, MISTY (DPT)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 REDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4660
Mailing Address - Country:US
Mailing Address - Phone:616-914-5299
Mailing Address - Fax:
Practice Address - Street 1:344 REDWOOD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4660
Practice Address - Country:US
Practice Address - Phone:616-914-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1254888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist